Expression Of Inducible Costimulatory Molecules And Inducible Costimulatory Ligands In Peripheral Blood Of Patients With Myasthenia Gravis

Objective To detect the changes of inducible costimulator(ICOS)and inducible costimulator ligand(ICOSL)in the serum of patients with myasthenia Gravis(MG),and to explore its clinical significance.Methods A total of 37 cases of MG patients diagnosed with MG who were admitted to the Department of Neurology,Affiliated Hospital of Qingdao University from February 2017 to October 2017 were included as a case group;there were 17 males and 20 females with a male to female ratio of 1:1.18;the average age was 56.84±14.33.(18-76)years old;duration of disease 5(2,48)months;19 cases of ocular MG,18 cases of general MG(based on modified Ossermannn classification);9 cases of thymoma,28 cases of non-thymoma;early on-set MG 15 cases(age of onset ? 50 years)and late-onset MG 22 cases(age> 50).At the same time,peripheral blood samples of 31 healthy people from the physical examination center of Qingdao University Affiliated Hospital were collected as a control group,including 13 males and 18 females.The male to female ratio was 1:1.38,and the average age was 50.10±17.02(20,82)years.The sera of patients and healthy controls were isolated and collected.The concentrations of soluble ICOS(sICOS)and soluble ICOSL(sICOSL)in serum of the two groups were detected by Enzyme-linked immunosorbent assay(ELISA).The differences between the two groups were tested.Whether the differences between the two groups were statistically significant.non-parametric rank sum test was used for comparison between groups,and correlation analysis between two variables was analyzed using Spearman correlation.Results(1)The serum ICOS level in MG cases was 53.86(36.53,77.20)pg/ml,which was significantly higher than that in healthy control group(30.97,24.45,56.94)pg/ml(P=0.001);the serum ICOSL level in MG case group was 218.00(144.53,317.81)Pg/ml was significantly higher than the healthy control group 150.00(114.95,195.68)pg/ml(P=0.002).(2)Subgroup results: Serum ICOS levels in the ocular form MG,General form MG,thymomas,and non-thymoma subgroups were significantly higher than those in the healthy control group(P=0.002,P=0.010,P=0.008,P=0.003);serum ICOS levels of the early-onset and late-onset MG were significantly higher than those in homogenous healthy controls(P=0.021,P=0.004).The ICOSL concentrations in serum were significantly higher in patients with MG,late-onset,non-thymoma subgroups than in healthy controls(P< 0.001,P=0.004,P=0.002),and serum ICOSL levels were not significantly different between patients with General form,early-onset,and thymoma subgroup MG and healthy controls.(3)Serum ICOSL expression levels in patients with MG were negatively correlated with MMT scores(r=-0.353,P=0.032).No significant correlation was found between ICOSL and QMG score and ADL score;In addition,serum ICOS levels in MG patients were not significantly correlated with QMG score,MMT score and ADL score.Conclusion The elevated levels of sICOS and sICOSL in MG patients suggest that ICOS/ICOSL signaling pathway is closely related to MG immunization and may be involved in the pathogenesis of MG.